Effects of molsidomine on global and regional left ventricular function at rest and during exercise in patients with angina pectoris

Although the antianginal properties of molsidomine are well‐established, little is known about its effects on global and regional left ventricular dysfunction secondary to myocardial ischemia. In the present study, left ventricular performance was assessed by radionuclide ventriculography at rest and during exercise in 15 patients with coronary artery disease (CAD) and angina pectoris before and after the administration of 2 mg molsidomine sublingually. Gated blood pool studies were performed for evaluation of left ventricular ejection fraction (LVEF) and regional wall motion by analyzing amplitudes and phases of the first Fourier coefficient of regional time–activity curves. In contrast to normal subjects, during the control study period LVEF in patients with CAD decreased from 50.9% at rest to 42.7% during exercise (p<0.01). After molsidomine the resting values of LVEF increased slightly from 50.9% to 55.7% (p<0.05). Exercise values of LVEF increased from 42.7% to 51.3% (p<0.01). This is usually associated with amelioration of anginal pain and ischemic ST depression in the precordial ECG (0.15 mV vs. 0.09 mV; p<0.01). Before molsidomine, regional wall motion deteriorated from rest to exercise in 11 of 15 patients. These wall motion abnormalities usually expressed themselves as newly developed regions of left ventricular dysfunction (8 patients) or as accentuation of pre‐existing contraction disturbances (3 patients). After molsidomine, regional wall motion did not show consistent changes at rest. Comparison during exercise showed enhanced regional function in 10 of the 15 patients after administration of the drug. At rest a slight but significant increase in heart rate was measured following molsidomine, whereas exercise heart rate remained unchanged. Only minor changes in systolic blood pressure occurred after molsidomine (rest, 143 mmHg vs. 134 mmHg; p<0.05; exercise, 177 mmHg vs. 174 mmHg; p>0.10). In conclusion, assessment of left ventricular performance at rest and during exercise in patients with CAD revealed significant improvement of global and regional left ventricular function, indicating reduction of myocardial ischemia. These effects may result primarily from reduction of left ventricular wall tension.